Significant for mild optic disk blurring she went to

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significant for mild optic disk blurring. She went to the local emergency department 5 days earlier with similar complaints and an MRI of the head was performed and reported as normal. The most appropriate next step in managing this case is to A. obtain an electroencephalogram B. obtain a neurosurgical consult C. perform a lumbar puncture D. repeat the MRI of the head E. start propranolol Explanation: The correct answer is C. The history and exam are typical for idiopathic intracranial hypertension (pseudotumor cerebri). The exact cause is unknown, but it is probably due to impaired reabsorption of cerebrospinal fluid leading to raised intracranial pressure. It usually occurs in obese, young women. Lumbar puncture
shows an elevated opening pressure and normal CSF. Acetazolamide may be used to lower intracranial pressure. Weight reduction is important. Obtaining an electroencephalogram (choice A) will not help with the diagnosis. There is no reason for a neurosurgical consult (choice B). Since nothing has changed since last week and she has the exact same symptoms, a repeat MRI of the head (choice D) is not indicated. It would be appropriate if she had different symptoms. Propranolol (choice E) is used for migraine prophylaxis and is not indicated here, as this patient's condition is consistent with idiopathic intracranial hypertension, and further evaluation is indicated. A 32-year-old woman comes to the office for her periodic health maintenance examination. She is with her 2-month-old baby. She tells you that her delivery was an uncomplicated vaginal delivery and that the baby is healthy. She is currently breastfeeding, with some bottled formula supplementation. She is feeling well and happy, and is thinking about going back to work as a financial analyst in a few weeks. She states that she and her husband walk for 30 minutes every morning. She has no medical problems, and has never had any surgery. She does not smoke, and only takes multivitamins and iron supplementation. She would like to have second child in about a year. Until then, she does not think that she "can handle" another pregnancy. She asks you about her contraceptive options. You should inform her that: A. A progestin-only method of contraception has no significant impact on milk production or quality B. If she wants an IUD she needs to wait another 2 months for her uterus to return to normal size C. She cannot use her diaphragm since her cervix and vagina are not yet "back to normal" D. She does not need any contraception as long as she is breastfeeding E. She should not take a combined triphasic pill as it will diminish milk production and quality
Explanation: The correct answer is A. Most authorities think that it is appropriate to initiate a progestin-only method of contraception immediately postpartum. It has no impact on lactation or the quality of breast milk.

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